Labour market strategies addressing precarious employment and its impacts: A systematic review

Abstract Background Precarious employment (PE), characterized by reduced worker rights, and employment and income insecurity, has complex public health implications including negative impacts on workers’ mental and physical health, occupational health and safety, wellbeing, and inequities in access to health and social protections. There is, however, a knowledge gap regarding effectiveness of interventions. We describe findings from a review of evaluated interventions with potential to address PE. Methods Our systematic review followed the 2020 PRISMA framework and covered PubMed, Scopus, Web of Science, and sources of grey literature. We included qualitative, quantitative, or mixed-methods studies evaluating initiatives to reduce workers’ PE published from 2000 to 2021 and focused on adult workers. Results The 23 eligible studies from across the world evaluated diverse strategies addressing PE including tax and trade reforms, industrial disputes legislation, business registration, and use of incentives to stimulate permanent contracts. Also included were union strategies to reach precarious workers, the provision of social benefits, and youth apprenticeships. Generally, while most initiatives had the potential to tackle certain PE aspects, they usually acted only on one or two PE dimensions. Additionally, the evaluation components were missing key details, thus, limiting the generalizability of findings, as did the heterogeneity of study designs, initiative purposes, economic and political context, and diverse populations targeted. Conclusions The increase in PE prevalence and its complex health implications requires sustainable upstream public health solutions. Multidisciplinary collaborations among public health and occupational health practitioners along with researchers, evaluation specialists, economists, and politicians could facilitate the implementation and evaluation of policies and standards regulating and monitoring PE and its health impacts. Key messages • Precarious employment has complex public health implications. • Sustainable solutions to address precarious employment must be upstream and multidisciplinary.

and work ability of the workforce. We assessed whether the long-term decrease in sickness absences in Finland is explained by observed and unobserved compositional changes in the workforce.

Methods:
Utilising register-based panel data on Finnish private and public sector employees aged 30-62, we examined the annual onset of compensated full sickness absence (granted after 10 working days) in the period 2005-2016. We applied random effects models adjusting for changes in observed sociodemographic factors of the study population. We also applied fixed effects models, with corrections of the estimates for cohort ageing, to additionally account for unobserved time-invariant characteristics of the study population over the years.

Results:
Of the observed factors, increases in educational level partly explained the decreasing trend in sickness absences, and more so among women than men and among private than public sector employees. Changes in occupational class and industrial sector played little role in the public sector and only slightly further explained the sickness absence trend in the private sector. The decreasing trend in sickness absences appeared to be largely explained by unobserved time-invariant individual characteristics.

Conclusions:
The decrease in sickness absences appeared to be more strongly influenced by compositional changes in factors that are established before fully entering the labour market -such as educational level as well as unmeasured individual characteristics that remain unchanged after childhood and early adulthood -than in the work environment or other factors contributing at working age. Attempts to improve the health and work ability of the workforce should not only rely on interventions directed at the working age population, but also on those carried out early during the life course.

Key messages:
Compositional changes in the workforce should be taken into account when assessing sickness absence trends. Interventions aiming to improve the health and work ability of the workforce should be implemented already early in the life course and not only in working age.

Background:
Employers play an important role in facilitating the return-towork (RTW) of employees after a prolonged sick leave. The involvement of employers in RTW efforts is however largely unexplored in an international comparative context. This paper provides evidence on the diffusion of procedures to support RTW after sick leave in European workplaces and discusses different policy approaches to involve employers in RTW.

Methods:
Employer activities are examined using microdata from the three waves of the European Survey on New and Emerging Risks (ESENER), collected in 2009, 2014 and 2019 (N = 47,425). ESENER is a representative company survey, conducted on behalf of the European Agency for Safety and Health at Work (EU-OSHA). The outcome of interest is information on the existence of a procedure to support employees' RTW after a long sickness absence. The analysis is carried out using logistic models, comparing countries and welfare state regimes.

Results:
Overall, 71.8% percent of workplaces with more than 50 employees have procedures to support RTW. Employer support is most common in Nordic and Anglo-Saxon countries (OR = 3.2, 95% CI 2.58-4.05 and OR = 8.9, 95% CI 5.41-14.68 respectively, compared to Continental countries and accounting for firm size and sector of activity

Background:
Precarious employment (PE), characterized by reduced worker rights, and employment and income insecurity, has complex public health implications including negative impacts on workers' mental and physical health, occupational health and safety, wellbeing, and inequities in access to health and social protections. There is, however, a knowledge gap regarding effectiveness of interventions. We describe findings from a review of evaluated interventions with potential to address PE.

Methods:
Our systematic review followed the 2020 PRISMA framework and covered PubMed, Scopus, Web of Science, and sources of grey literature. We included qualitative, quantitative, or mixed-methods studies evaluating initiatives to reduce workers' PE published from 2000 to 2021 and focused on adult workers.

Results:
The 23 eligible studies from across the world evaluated diverse strategies addressing PE including tax and trade reforms, industrial disputes legislation, business registration, and use of incentives to stimulate permanent contracts. Also included were union strategies to reach precarious workers, the provision of social benefits, and youth apprenticeships.

Background and Objective:
Population-based estimates of the socioeconomic burden of multiple sclerosis (MS) are limited, especially regarding primary healthcare. This study aimed to estimate the excess costs of people with MS that could be attributed to MS, including primary healthcare.

Methods:
An observational study was conducted of the 2806 workingaged people with MS in Stockholm, Sweden and 28,060 propensity score matched references without MS. Registerbased resource use was quantified for 2018. Annual healthcare costs (primary, specialised outpatient, and inpatient healthcare visits along with prescribed drugs) and productivity losses (operationalised by sickness absence and disability pension days) were quantified using bottom-up costing. Costs were compared between the people with MS and references with independent t-tests with bootstrapped 95% confidence intervals (CIs) to isolate the excess costs of MS.

Results:
The mean annual excess costs of MS for healthcare were E7381 (95% CI: 6991-7816) per person with MS with disease modifying therapies as the largest component (E4262, 95% CI: 4026-4497). There was a mean annual excess cost for primary healthcare of E695 (95% CI: 585-832) per person with MS, comprising 9.4% of the excess healthcare costs of MS. The mean annual excess costs of MS for productivity losses were E13,173 (95% CI: 12,325-14,019) per person with MS, predominately from disability pension (79.3%).

Conclusions:
The socioeconomic burden of MS in Sweden from healthcare consumption and productivity losses was quantified, updating knowledge on the cost structure of the substantial excess costs of MS. Key messages: Primary healthcare contributes around a tenth of the excess healthcare costs of MS in Sweden, primarily owing to contacts with healthcare professionals other than physicians.
Overall, the excess costs of MS in Sweden from lost production are larger in magnitude than the excess costs for healthcare consumption.

Background:
Theoretical and empirical studies indicate that a lack of transparency and highly complexity makes it difficult for patients to navigate healthcare systems. This requires the competence to access, understand, appraise, and apply information about the healthcare system, its organizations and proceedings, i.e., navigational health literacy. Since little is known about navigational health literacy, partly due to a lack of measurement tools, a new instrument measuring navigational health literacy was developed as part of the Health Literacy Population Survey Project 2019-2021 (HLS19). It was applied in national health literacy surveys of the three Germanspeaking countries Austria, Germany and Switzerland among others. The empirical findings obtained in the three Germanspeaking countries and further perspectives on the topic will be presented and discussed in the workshop.

Objectives of the workshop:
The workshop on navigational health literacy has three key objectives: 1) It gives an overview on the newly developed instrument for measuring navigational health literacy in HLS19, its development and validation; 2) it aims to discuss the distribution of navigational health literacy among the Austrian, German, and Swiss population and to highlight barriers and challenges for patients regarding navigation health literacy; and finally 3) it proposes steps to promote and strengthen navigational health literacy. Added value of the workshop: The workshop is designed to enhance the understanding of navigational health literacy and to propose future scenarios and steps for action to develop and implement better health literacy outcomes. By the end of the workshop, participants -will have discussed the methodological approach for measuring navigational health literacy; -will have heard of current data and developments regarding navigation health literacy in Austria, Germany and Switzerland; -will have exchanged ideas and sustainable strategies to strengthen healthcare systems by developing navigational health literacy.